Provider Demographics
NPI:1952465379
Name:GILLESPIE, ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N HIGGINS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4524
Mailing Address - Country:US
Mailing Address - Phone:406-542-3333
Mailing Address - Fax:406-542-3365
Practice Address - Street 1:420 N HIGGINS AVE STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4524
Practice Address - Country:US
Practice Address - Phone:406-542-3333
Practice Address - Fax:406-542-3365
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1679PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061061OtherBLUE CROSS OF MONTANA
MT3401666Medicaid
MT000061061OtherBLUE CROSS OF MONTANA
MT3401666Medicaid